Explore every episode of the podcast The 2AM Consult

Recurrent yeast infections are frustrating for veterinarians, uncomfortable for patients, and increasingly difficult to manage. But when a Malassezia infection doesn't respond to appropriate treatment, is it truly resistance—or is something else being missed?

In this episode of 2 AM Consult, emergency veterinarian Dr. Courtney Deer sits down with board-certified veterinary dermatologist Dr. Millie Rosales to discuss the growing concern of antifungal-resistant yeast infections in dogs. They explore how to recognize treatment failure, why recurrent otitis and dermatitis almost always have an underlying cause, and the practical steps every veterinarian can take to improve outcomes before reaching for another medication.

Topics covered include:
• Why recurrent ear infections are usually a symptom—not the primary disease
• When to suspect antifungal resistance versus poor compliance or uncontrolled inflammation
• The importance of ear cytology in every otitis case
• Managing inflammation to improve patient comfort and treatment success
• Practical approaches to recurrent otitis in ER and general practice
• Ear cleaners, long-acting medications, and selecting appropriate antifungal therapy
• When it's time to refer a patient to a veterinary dermatologist
• Why better surveillance of resistant yeast infections may be needed

Whether you work in emergency medicine or general practice, this episode is packed with practical dermatology pearls you can apply to your next itchy patient.

Whether you're working an overnight ER shift or seeing neurologic cases in general practice, neurology can feel intimidating—but it doesn't have to be. In this episode of 2 A.M. Consult, Dr. Deer is joined by board-certified veterinary neurologist Dr. James Cellini to break down some of the most common neurologic emergencies into practical, immediately applicable clinical pearls.

Together, they discuss the approach to seizure patients, choosing anticonvulsants, managing cluster seizures, assessing deep pain in IVDD patients, and why deep pain—not withdrawal reflexes—is one of the most important prognostic indicators. They also cover vestibular disease, differentiating central versus peripheral lesions, when time can be your best diagnostic tool, and how to approach referral conversations with pet owners.

Rather than focusing on complex neuroanatomy, this episode is packed with practical decision-making tips, common misconceptions, and real-world advice that emergency and general practice veterinarians can apply on their very next shift.

In this episode you'll learn:
• The first neurologic exam finding to assess in a comatose patient
• Practical seizure management pearls and rescue medication protocols
• How to differentiate withdrawal reflexes from true deep pain perception
• Medical management versus surgical considerations for IVDD
• How to localize vestibular disease and when to suspect central disease
• Tips for discussing neurologic referrals and prognosis with clients

If you've ever found yourself staring at a seizuring patient, a rolling vestibular dog, or a suddenly paraplegic Dachshund at 2 a.m. wondering what to do next, this episode is for you.

Episode Description

Seizures are one of the most common neurologic emergencies encountered in general practice and the ER—but they're also one of the most misunderstood. In this episode of 2 A.M. Consult, Dr. Deer is joined by board-certified veterinary neurologist Dr. Ryan Gibson to break down a practical, evidence-based approach to seizure patients.

Together they discuss how to distinguish seizures from other collapse events, the diagnostic workup for first-time seizures, when MRI and CSF analysis are (and aren't) indicated, and how to build confidence diagnosing idiopathic epilepsy. They also cover when to start anti-seizure medications, choosing between phenobarbital, levetiracetam, zonisamide, and potassium bromide, monitoring recommendations, rescue medications for cluster seizures, and what current evidence says about supplements, diets, and CBD.

Whether you're a GP veterinarian, emergency clinician, or veterinary student, this episode is packed with practical clinical pearls you can apply to your very next seizure case.

Can a patient lose vision in just a few hours? With glaucoma, the answer is yes.

In this episode of The 2 AM Consult, Dr. Deer sits down with board-certified veterinary ophthalmologist Dr. Alex Sigmund (The Vet Eye Guy) to discuss one of the most time-sensitive ophthalmic emergencies encountered in general practice and the ER.

Together they cover:

• What glaucoma actually is—and why it's a true emergency
• Primary vs. secondary glaucoma
• Breed predispositions and clinical signs
• Tonometry tips and common diagnostic mistakes
• Emergency treatment protocols, including when to use dorzolamide, latanoprost, mannitol, and aqueocentesis
• Pain management and long-term monitoring
• When to refer to ophthalmology
• Surgical options and when enucleation is the best choice

Whether you're a GP veterinarian, ER clinician, intern, or student, this episode is packed with practical, evidence-based pearls you can apply the very next time a painful red eye walks through the door.

Guest: Dr. Alex Sigmund, DVM, DACVO
Board-Certified Veterinary Ophthalmologist | Co-founder of The Veterinary Eye Team | @TheVetEyeGuy

CHAPTERS

00:00 Introduction to Dr. Sigmund and Episode Overview

00:36 What is Glaucoma in Veterinary Medicine?

01:30 Causes of Glaucoma: Primary and Secondary

02:32 Breed Predispositions and Screening Methods

04:13 Clinical Signs of Glaucoma in Pets

07:04 Diagnostic Approach and Criteria for Glaucoma

13:59 Medical Management and Emergency Protocols

19:59 Surgical and End-Stage Treatment Options

44:33 Key Takeaways and Final Advice from Dr. Sigmund

Welcome to the 2AM Consult Podcast! On this podcast I interview experts in the veterinary field about topics they wish they could share far and wide. You'll learn about diseases, procedures and so much more from those closest to the material.

Launching August 4th, new episodes every other Tuesday!